S.C. Radiologia Ospedale Maggiore, Piazza Ospitale 1, IT-34129, Trieste, Italy.
Department of Radiology, University of Trieste, Strada di Fiume 447, IT-34149, Trieste, Italy.
Eur Radiol. 2018 Feb;28(2):683-691. doi: 10.1007/s00330-017-5023-5. Epub 2017 Aug 30.
Many radiologists and clinicians still consider multiple myeloma (MM) and monoclonal gammopathies (MG) a contraindication for using iodine-based contrast media. The ESUR Contrast Media Safety Committee performed a systematic review of the incidence of post-contrast acute kidney injury (PC-AKI) in these patients.
A systematic search in Medline and Scopus databases was performed for renal function deterioration studies in patients with MM or MG following administration of iodine-based contrast media. Data collection and analysis were performed according to the PRISMA statement 2009. Eligibility criteria and methods of analysis were specified in advance. Cohort and case-control studies reporting changes in renal function were included.
Thirteen studies were selected that reported 824 iodine-based contrast medium administrations in 642 patients with MM or MG, in which 12 unconfounded cases of PC-AKI were found (1.6 %). The majority of patients had intravenous urography with high osmolality ionic contrast media after preparatory dehydration and purgation.
MM and MG alone are not risk factors for PC-AKI. However, the risk of PC-AKI may become significant in dehydrated patients with impaired renal function. Hypercalcaemia may increase the risk of kidney damage, and should be corrected before contrast medium administration. Assessment for Bence-Jones proteinuria is not necessary.
• Monoclonal gammopathies including multiple myeloma are a large spectrum of disorders. • In monoclonal gammopathy with normal renal function, PC-AKI risk is not increased. • Renal function is often reduced in myeloma, increasing the risk of PC-AKI. • Correction of hypercalcaemia is necessary in myeloma before iodine-based contrast medium administration. • Bence-Jones proteinuria assessment in myeloma is unnecessary before iodine-based contrast medium administration.
许多放射科医生和临床医生仍然认为多发性骨髓瘤（MM）和单克隆丙种球蛋白病（MG）是使用碘基造影剂的禁忌症。ESUR 造影剂安全委员会对这些患者使用碘基造影剂后发生对比剂急性肾损伤（PC-AKI）的发生率进行了系统回顾。
在 Medline 和 Scopus 数据库中进行了系统搜索，以寻找 MM 或 MG 患者使用碘基造影剂后肾功能恶化的研究。根据 PRISMA 2009 声明进行数据收集和分析。事先指定了纳入标准和分析方法。纳入了报告肾功能变化的队列研究和病例对照研究。
选择了 13 项研究，这些研究报告了 642 例 MM 或 MG 患者中 824 次碘基造影剂给药，其中发现了 12 例无混杂因素的 PC-AKI 病例（1.6%）。大多数患者在准备性脱水和通便后接受了静脉尿路造影术，使用高渗透压离子型造影剂。
MM 和 MG 本身并不是 PC-AKI 的危险因素。然而，在脱水和肾功能受损的患者中，PC-AKI 的风险可能显著增加。高钙血症可能增加肾脏损伤的风险，应在造影剂给药前纠正。在给予碘基造影剂之前，不需要评估 Bence-Jones 蛋白尿。
• 单克隆丙种球蛋白病包括多发性骨髓瘤是一大类疾病。• 在肾功能正常的单克隆丙种球蛋白病中，PC-AKI 的风险并未增加。• 在骨髓瘤中，肾功能常降低，增加了 PC-AKI 的风险。• 在给予碘基造影剂之前，骨髓瘤中的高钙血症必须纠正。• 在给予碘基造影剂之前，骨髓瘤中的 Bence-Jones 蛋白尿评估是不必要的。
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